The Health Care Finance Administration (HCFA) has funded a randomized controlled trial to test the effectiveness of: (1) a primary care practice-attached nurse care manager called a "health promotion nurse (HPN), (2) a "voucher" (V) used to pay for augmented home and community-based care, and (3) a combination of HPN and voucher (HPN+V). One thousand six hundred functionally impaired, community living, Medicare eligible patients who are at high risk for hospitalization are being recruited from over 150 primary care practices in New York, West Virginia, and Ohio. Randomization of subjects to one of the three treatment arms or a "care as usual" arm began in June, 1998. The duration of the intervention is 24 months. The proposed study seeks to take advantage of the opportunity to add an oral health intervention component to this on-going study. The long-term goal of our work is to develop effective strategies for oral health promotion and dental disease prevention in community-dwelling adults. The underlying theme for the interventions is that of empowerment for patients in the management of their health. This proposal seeks to place oral health within the context of general health and will serve as a first step toward development of comprehensive interventions that address potential links between oral disease activity and systemic disease. Four specific aims will broadly address the following questions: (1) What is the distribution of oral health status among an elderly population with high levels of depression and chronic disease who are at risk for hospitalization?; (2) What impact does a Health Promotion Nurse, trained in oral health promotion, have on oral health status in elderly adults?; (3) Do individuals who improve their oral health status experience better general health outcomes?,and (4) What future research hypotheses appear to hold promise for improving the oral health of older adults? The opportunity to link an oral health intervention study with the on-going HCFA study is exceptional for four reasons: First, the intervention model has been shown to be effective in other diseases. Second, a rich set of relevant variables is already being collected. Third, a relevant study population has been identified and is being enrolled. Finally, given the current interest in links between periodontal disease and coronary heart disease, there is an urgent need to test oral health interventions within the context of systemic disease.